title: Immune deviation in recurrent vulvovaginal candidiasis: correlation with iron deficiency anemia.
abstract: BACKGROUND
  Iron Deficiency Anemia (IDA) has been controversially linked to IL-4 production in previous studies. A predominant Th1 response leads to resistance against recurrent vulvovaginal candidiasis (RVVC), whereas a Th2 response exacerbates the disease.
  
  
  OBJECTIVE
  To investigate the possible effect of iron deficiency on the host's susceptibility to RVVC as a result of the Th1/Th2 cytokine polarization.
  
  
  METHODS
  We conducted a case-control study of 92 women in 4 groups based on strict inclusion and exclusion criteria: RVVC+IDA+ group consisted of 23 women with RVVC and IDA; RVVC+ IDA- group consisted of 23 women with RVVC without IDA; RVVC-IDA+ group consisted of 23 women without RVVC and with IDA and RVVC- IDA- group consisted of 23 healthy women. The iron parameters and key cytokines (IFN-γ, IL-10, IL-12, IL-4) were measured in blood samples.
  
  
  RESULTS
  Comparison of IL-4 production between RVVC+ IDA+ (12.2 ± 1.3 pg/ml) and RVVC+ IDA- (2.4 ± 4.0 pg/ml) groups (p=0.044), between RVVC- IDA+ (14.6 ± 1.7 pg/ml) and RVVC- IDA- (1.28 ± 3.6 pg/ml) groups (p=0.006), between RVVC- IDA+ (14.6 ± 1.7 pg/ml) and RVVC+ IDA-) 2.4 ± 4.0 pg/ml) groups (p=0.009) and also between RVVC+ IDA+ and RVVC- IDA- (1.28 ± 3.6 pg/ml) groups (p=0.03) showed significant differences. We found a significant positive correlation between IL-4 and total iron binding capacity (TIBC, p=0.046) and between serum IL-10 and Hb levels (p=0.041) in the RVVC+ IDA- group. There was also a significant negative correlation between serum IL-4 and levels of serum iron (SI, p=0.041) in the RVVC- IDA- group.
  
  
  CONCLUSIONS
  It seems that IDA determines the balance between and the intensity of Th1 and Th2 arms of the immune response and leads to a deviation toward Th2 response which could contribute to recurrence of candidiasis.
authors.affiliation: Department of Immunology, Hormozgan University of Medical Sciences, Bandar Abbas, Iran, e-mail: naderi@hums.ir.
authors.forename: Nadereh
authors.initials: N
authors.lastname: Naderi
authors.forename: Zahra
authors.initials: Z
authors.lastname: Etaati
authors.forename: Mansoreh
authors.initials: M
authors.lastname: Rezvani Joibari
authors.forename: Seyed Alireza
authors.initials: SA
authors.lastname: Sobhani
authors.forename: Said
authors.initials: S
authors.lastname: Hosseni Tashnizi
mesh_terms: D000328:Adult; D018798:Anemia, Iron-Deficiency / Q000150:complications / Q000276:immunology*; D002181:Candidiasis, Vulvovaginal / Q000150:complications / Q000276:immunology*; D016022:Case-Control Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000097:blood; D008875:Middle Aged; D012008:Recurrence; D058408:Th1-Th2 Balance; D018418:Th2 Cells / Q000276:immunology*; D055815:Young Adult
chemical_list: D016207:Cytokines; D006454:Hemoglobins; D007501:Iron